Fighting the Common Cold and the Flu

Fighting the Common Cold and the Flu
Part Two

Part One of this article looked at using vitamin C and zinc lozenges for the common cold. This second part will look at additional supplements for both the common cold and the flu.

Supplements
(continued)

Echinacea:
Echinacea is an herbal remedy that is promoted as enhancing the immune system. But does it work? Two studies I came across were designed to determine if taking echinacea on a regular basis would reduce the incidence of colds or the flu. The first study found that echinacea had no effect while the second found it had only a very mild effect. So there does not appear to be much reason to take it on a daily basis.

The first study also looked at if taking echinacea at the first sign of a cold or flu reduced the duration thereof. And it also found no effect from the echinacea. However, a couple of other studies I came across did find that it reduced the duration of colds. One found that it reduced the length of a cold from nine days in the placebo group to six days in the test group.

A meta-analysis of 16 different studies reported that the majority of the studies found a positive effect from echinacea. However, it stated that due to variations in the potency of the different echinacea preparations used, it was hard to draw any firm conclusions. And such problems are common when investigating supplements.

Since the FDA does not regulate supplements, you can never be sure if a supplement contains the full amount of the stated quantity of the substance and of what its quality is. There can especially be variations in the case of herbal supplements since different preparations might use different parts of the plant or standardize it to different strengths of the purported active ingredients. Also, some studies used echinacea capsules while others used echinacea tea. And this could make a difference in study results.

It should also be mentioned that some studies on echinacea reported that some test subjects experienced mild side effects from the echinacea, but the exact nature of these side effects were not specified in the abstracts.

Elderberry:
Elderberry is another herbal remedy that is promoted as being effective for the reduction of cold and flu symptoms. It is commonly sold under the trade name of Sambucol®. However, I could only find one study that looked at the effectiveness of elderberry. This study found that elderberry significantly reduced the severity and duration of the flu symptoms of test subjects. The flu symptoms cleared up within six days in the control group but within three days in the test group.

However, one study is not much to go on. So until more research is conducted, it's hard to give any recommendations on elderberry.

Garlic:
In one study I came across, supplements of garlic were found to reduce the number of colds among test subjects as compared to a control group. And when those in the test group got colds, they recovered more quickly than those in the control group.

So it would seem that garlic supplementation would be an effective means of preventing and treating the common cold. But I was only able to find this one study. So again, it is hard to draw conclusions.

However, regular garlic intake has many other possible health benefits. It might be beneficial in reducing the risk of cancer and heart disease, at lowering blood pressure, and at improving blood lipid profiles. So regular intake of garlic through supplements or simply by using it regularly in food preparation would not be a bad idea whether it helps prevent the common cold or not.

Goldenseal:
Goldenseal is an herb that is often included with echinacea in herbal preparations. But I was not able to find any studies that have been done on goldenseal in regards to its effect on colds and the flu. So no recommendations are possible.

Homeopathic Remedies

A discussion of homeopathy in general is beyond the scope of this article. However, many homeopathic remedies are promoted as being beneficial for colds and the flu. Two of these in particular are readily available, being sold at many pharmacies, health food stores, and online supplement sites.

Zicam:
The first of these homeopathic remedies is Zicam® Cold Remedy. This is a zinc nasal gel. The packaging for Zicam refers to a study that was done showing its effectiveness at reducing the length of the common cold. I was able to find this study on PubMed.

The study looks to be a sound study. It used a total of 213 participants, with 108 receiving the remedy and 105 receiving a placebo. The average length of cold symptoms among the test group was 2.3 days versus 9.0 days for the placebo group.

But once again, this is only one study. However, the reduction in terms of duration of cold symptoms from the Zicam in this study is about the same as the 85% reduction of symptoms found in the study discussed in Part One of this article that used six grams of vitamin C. And this level of reduction is the greatest I found among all of the studies I looked at. So along with vitamin C, Zicam is worth considering.

It should also be noted that, given the nature of homeopathy, the actual amount of zinc in Zicam is very small. So unlike zinc lozenges, there is no chance that Zicam would put one over the top in terms of the upper tolerable limit for zinc.

Oscillococcinum:
The second homeopathic remedy is Oscillococcinum®. This remedy is prompted as being able to reduce the length of the flu if it is taken immediately at the onset of symptoms.

A search on Oscillococcinum turned up three abstracts that mentioned it. Two simply mentioned in passing that Oscillococcinum was "promising" as a treatment for the flu but that more research was needed. The third was a meta-analysis that looked at seven different studies done on Oscillococcinum. But it stated that only two provided sufficient data to draw conclusions from, and the conclusion was that it was mildly effective at reducing the length of flu symptoms. So whether it is worth trying or not is hard to say.

Personal Practices and Experiences

I have not had the flu or anything more serious than a minor head cold in over two and a half years. And it should be noted that over the holidays I was around a lot of people who were sick. It seemed like everyone in my family was coughing and sneezing, except me. But I never caught any of their colds. I believe this is because I have been meticulous about following the lifestyle practices discussed in Part One of this article. And I believe that if more people followed such practices there would be a greatly reduced rate of colds and flu in the general population.

The powerlifting training I engage in would be considered strenuous activity, so this could put me at higher risk of colds and the flu. But I include 12 ounces of orange juice (for the carbohydrate and nutrient content) in my post-workout drink. Plus the multiple vitamin/ mineral supplement that I take daily (Jarrow Formula's Multi Easy Powder) contains 500 mg of vitamin C. These together counter any possible immune suppression from my workouts.

In addition, it has been my practice ever since high school to keep a bottle of 500 mg tablets of vitamin C on hand at all times. Anytime I feel like a cold is coming on I'll take one tablet every hour or two. And there have been many times over the years when I felt like a cold was coming on, took the vitamin C, and did not get sick.

Now I have no way of knowing if I would have actually gotten sick if I hadn't taken the vitamin C, but there seemed to be no reason not to. Vitamin C is very inexpensive, and the only side effect I have ever experienced is sometimes I will start to urinate frequently. If that happens I simply stop the treatment, and the problem clears up.

In the 1990s the idea of using zinc lozenges for colds was widely promoted. So at that time, I began using zinc lozenges along with the vitamin C when I felt a cold coming on. Then most recently I came across Zicam Cold Remedy, and started taking that as well.

As for how effective these three are, in the past two and half years there have been a couple of times when I began to experience the symptoms of a head cold. So I used all three of these, the vitamin C, the zinc lozenges, and the Zicam, and both times the cold symptoms never got very severe. I even went to the gym and worked out with no problems. And the symptoms cleared up completely after a couple of days.

Now again, if I would have suffered with even worse symptoms or if the symptoms would have lasted longer without the vitamin C, zinc lozenges, and Zicam is impossible to say. But I do plan on continuing to use the vitamin C and Zicam whenever I feel a cold coming on. Both are relatively inexpensive and safe, so there's no reason not to use them. And these are the two proposed remedies for the common cold that had the greatest effect on the severity and duration of cold symptoms. So they seem to be worth taking.

However, given that the Jarrow's Multi I am now taking contains plenty of zinc and that my diet is rich in zinc, it could actually be counter-productive for me to use zinc lozenges in the future. Doing so might put me over the upper tolerable limit for zinc. So I doubt I will use zinc lozenges the next time I feel a cold coming on.

The last time I had the flu was almost three years ago. For it I took echinacea on a regular basis, but it did not seem to have any effect. The flu lasted about eight days, and my temperature stayed between 100-101 degrees the entire time. This would seem to be about a "normal" course for the flu. So although there is some evidence supporting the effectiveness of echinacea, it didn't seem to work for me.

It was after that flu bout that I first heard about Oscillococcinum, so I purchased a box to have around. But since then, thank God, I have not had an occasion to use it. So I cannot say if it would be effective for me or not. But given the lack of effect of the echinacea, I will probably try the Oscillococcinum if I feel a flu coming on.

As for garlic, I was taking garlic supplements at one time. But now I simply use garlic quite frequently in food preparation. So maybe that is helping in keeping colds and the flu at bay as well.

Recommendations

The following recommendations are based the results of my research and my own personal experiences. However, I am not a doctor, so by making these recommendations I am not "prescribing" anything. The reader will need to decide for yourself, in consultation with your doctor, whether any of these would be applicable to you.

That said, following a healthy diet rich in fruits and vegetables, getting regular exercise and adequate sleep, controlling stress, not smoking, and washing your hands and disinfecting contaminated surfaces-all of these are "no-brainers." If you want to be and stay healthy, these are all sound practices. Even if they don't prevent you from getting sick, you'll probably be able to recover quicker and have less severe symptoms if you have been following a healthy lifestyle. And all of these practices have benefits beyond just fighting colds and flu.

As for supplements, in regards to colds, vitamin C seems to be the supplement that has the greatest amount of evidence supporting it. And the evidence shows that relatively large total amounts split up over several small doses through the course of the day works best.

So at the first sign of a cold, I would recommend starting to take 500-1000 mg (1/2 - 1 gram) of vitamin C every hour or two for up to a total of six grams on the first day. Then on the second and following days, take about half of this amount. It would probably also be wise to continue to take it for 24 hours or so after the cold symptoms subside to be sure the cold is really "knocked out."

As for zinc lozenges, the evidence of their effectiveness is rather split. Also, taking them can actually be counter-productive for people who are already consuming close to the upper tolerable limit for zinc or if they are taken too often or in excessive amounts.

But if you do take them I will say this, most zinc lozenges contain between 5-15 mg of zinc. So I would recommending adding up how much zinc you are getting in any supplements you might be taking and estimating how much zinc you're getting in your diet (10-15 mg is probably an average amount), and then only taking the number of lozenges that will take you up to but not over the upper limit of 40 mg. It would probably also be best to spread out the lozenges, taking one every couple hours or so.

Zicam is an interesting cold remedy. With only study supporting it, it's hard to give a firm recommendation for it. But that study did find a very significant effect from it. And homeopathic remedies by their very nature are generally side effect free. And it's not too expensive. So it probably would be worth a try. Just take it according to label directions, which is one spray in each nostril every four hours. The label states that it works best if it is started at the first sign of a cold and recommends continuing to take it for 48 hours after symptoms subside.

As for the flu, echinacea would be the most likely candidate. But the evidence for it is not completely clear-cut. Add in my own lack of benefit from it, and I cannot fully recommend it.

Given the variability among echinacea preparations, it's hard to give specific recommendations as to which brand and form (capsules or tea) might be most effective and what kind of dosages to use. The best that can be said is, if you're going to use echinacea, then purchase a high-quality brand and take it according to label directions.

The other herbal preparation, elderberry, might be beneficial. The one study on it did find a significant effect, so it might be worth a try. Again, due to product variability, take it according to label directions.

As for Oscillococcinum, as the studies I looked at said, it looks "promising" as a treatment for the flu. So it might be worth having around. But it is somewhat more expensive than most of the other supplements discussed here.

The dosage on Oscillococcinum is rather interesting. You are supposed to take three doses, spaced six hours apart, starting with the first onset of symptoms, and that's it. So basically, if it's going to help, it will do so right away or not all at. Given this dosage recommendation, it is generally sold in three or six dose boxes.

Regular garlic use would be a good idea, not just for colds and the flu, but for other reasons as well. And beside, it tastes great! But if you don't like the taste or possible breath effects, then "odor-free" supplements are available.

References

Note: PMID refers to the PubMed ID number. This number is included so that the reader can easily find the referenced abstract. Simply do a search on the number on PubMed.

Echinacea:
Am J Med. 1999 Feb;106(2):138-43. A randomized controlled trial of the effect of fluid extract of Echinacea purpurea on the incidence and severity of colds and respiratory infections. Grimm W, Muller HH. PMID: 10230741.
Arch Fam Med. 1998 Nov-Dec;7(6):541-5. Echinacea root extracts for the prevention of upper respiratory tract infections: a double-blind, placebo-controlled randomized trial. Melchart D, Walther E, Linde K, Brandmaier R, Lersch C. PMID: 9821828.
J Altern Complement Med. 2000 Aug;6(4):327-34. The efficacy of echinacea compound herbal tea preparation on the severity and duration of upper respiratory and flu symptoms: a randomized, double-blind placebo-controlled study. Lindenmuth GF, Lindenmuth EB. PMID: 10976979.
Cochrane Database Syst Rev. 2000;(2):CD000530. Echinacea for preventing and treating the common cold. Melchart D, Linde K, Fischer P, Kaesmayr J. PMID: 10796553.

Elderberry:
Eur Cytokine Netw. 2001 Apr-Jun;12(2):290-6. The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines. Barak V, Halperin T, Kalickman I. PMID: 11399518.

Garlic:
Adv Ther. 2001 Jul-Aug;18(4):189-93. Preventing the common cold with a garlic supplement: a double-blind, placebo-controlled survey. Josling P. PMID: 11697022.
J Hypertens. 1994 Apr;12(4):463-8. A meta-analysis of the effect of garlic on blood pressure. Silagy CA, Neil HA. PMID: 8064171.
Curr Cancer Drug Targets. 2003 Feb;3(1):67-81. Garlic [Allium sativum]: a review of its potential use as an anti-cancer agent. Thomson M, Ali M. PMID: 12570662.
Am J Clin Nutr. 1996 Dec;64(6):866-70. A double-blind crossover study in moderately hypercholesterolemic men that compared the effect of aged garlic extract and placebo administration on blood lipids. Steiner M, Khan AH, Holbert D, Lin RI. PMID: 8942410.

Zicam:
Ear Nose Throat J. 2000 Oct;79(10):778-80, 782. Zinc nasal gel for the treatment of common cold symptoms: a double-blind, placebo-controlled trial. Hirt M, Nobel S, Barron E. PMID: 11055098.

Oscillococcinum:
Cochrane Database Syst Rev. 2000;(2):CD001957. Homoeopathic Oscillococcinum for preventing and treating influenza and influenza-like syndromes. Vickers AJ, Smith C. PMID: 10796675.
BMC Complement Altern Med. 2001;1(1):4. Epub 2001 Jul 20. Systematic reviews of complementary therapies - an annotated bibliography. Part 3: homeopathy. Linde K, Hondras M, Vickers A, ter Riet G, Melchart D. PMID: 11527508.
Prim Care. 2002 Jun;29(2):231-61. Respiratory and allergic diseases: from upper respiratory tract infections to asthma. Jaber R. PMID: 12391710.

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The above article was published in the FitTips for One and All newsletter.
It was posted on this site January 11, 2004.

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